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(Reuters Health) – Hurricane Maria claimed the lives of 4,645 people in Puerto Rico last year and not the 64 long pegged by the island’s government as the official death toll, according to a survey of thousands of residents by a research team led by Harvard University.

The researchers estimated that most victims of the storm died between Sept. 20 and Dec. 31, 2017, as a direct or indirect result of Puerto Rico’s worst natural disaster in 90 years. One-third perished because of delayed or interrupted medical care.

While cautioning that the estimate of 4,645 victims may be too low, the researchers said the numbers “underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico.”

The tally, reported online on Tuesday in the New England Journal of Medicine, is likely to be controversial because it is far higher than previous independent estimates.

The emergency response to the disaster became highly politicized and provoked criticism of President Donald Trump, who was faulted when much of the U.S. territory remained without power for months.

Puerto Rico’s government released a statement on Tuesday welcoming the study and saying it would analyze it further.

In the aftermath of the storm, Puerto Rico commissioned George Washington University to conduct an independent study into the death toll, the results of which are due soon.

“As the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities. We have always expected the number to be higher than what was previously reported,” Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration said in the government statement.

The chief author of the new study, Caroline Buckee of the Harvard T.H. Chan School of Public Health in Boston, did not respond to emails requesting comment.

Maria, a major hurricane with winds close to 150 miles (241 km) per hour, caused an estimated $90 billion in damage to an island already struggling economically and many residents have subsequently left.

There is a wide margin for error in the study authored by Buckee. While the researchers estimated 4,645 deaths, the actual number could be as low as 793 and as high as 8,498, the study showed.

The tally of 4,645 dead is more than four times higher than a December estimate by the New York Times, which said the actual death toll was probably about 1,052.

A Pennsylvania State University study put the number at 1,085.

The Buckee team randomly conducted in-person surveys of 3,299 of the estimated 1.1 million Puerto Rican households earlier this year, making sure to include remote areas.

Respondents were not paid and were asked if a household member had died directly or indirectly as a result of the storm. Missing people were not counted as deaths. Respondents were also asked about deaths within a five-minute walking distance of their homes.

The Buckee team also said that in the aftermath of the storm households went, on average, 68 days without water, 84 days without electricity and 41 days without cell phone coverage. In the most remote areas, 83 percent of the households were still without power by Dec. 31.

(Reporting by Gene Emery; Additional reporting by Daniel Bases in New York; Editing by Tom Brown)

GENEVA (Reuters) – Miami is at risk of a deadly yellow fever outbreak because the disease could thrive there but the city has no checks on travelers arriving from endemic zones, a study to be published by the World Health Organization showed.

Yellow fever is spread by the same mosquito that causes Zika virus, which spread through the Americas after being detected in Brazil in 2015 and has been reported in southern Florida and southern Texas.

The U.S. Centres for Disease Control advises that yellow fever is found in tropical and subtropical areas of Africa and South America, and is a very rare cause of illness in U.S. travelers.

But the study, “International travel and the urban spread of yellow fever”, showed that almost 2.8 million people flew to the United States from endemic yellow fever areas in 2016.

Unlike some countries, the United States does not require travelers from such places to show proof of yellow fever vaccination.

“At a time when global yellow fever vaccine supplies are diminished, an epidemic in a densely populated city could have substantial health and economic consequences,” the researchers based in Canada, the United States and Britain wrote in the study.

Around 9.5 million people live in U.S. urban areas such as Miami that are ecologically suitable for an outbreak, they wrote in the study, issued online ahead of its publication in the Bulletin of the World Health Organization.

They said climate change, mobility, urbanization and a vaccine shortage had increased the risk of yellow fever globally and they called for a review of vaccination policies.

The study found 472 cities suitable for an outbreak in 54 countries, but many, such as New Delhi, Mumbai, Karachi, Manila and Guangzhou, required vaccination certificates on arrival from endemic countries.

WHO spokeswoman Fadela Chaib said the need for vaccination certificates was at each country’s discretion.

The researchers said a substantial proportion of the world’s yellow fever vaccine stocks had been used up by recent epidemics in Africa and Brazil, and further depleted by manufacturing difficulties. Preventive campaigns could cause shortages.

“Should another urban epidemic occur in the near future, vaccine demand could easily exceed the available supply,” they said.

Yellow fever, which can be hard to diagnose, causes symptoms including muscle pain, nausea and vomiting, and about 15 percent of cases lead to a more toxic phase within 24 hours, potentially experiencing jaundice, abdominal pain, deteriorating kidney function and bleeding from the mouth, nose, eyes or stomach.

Half of severe sufferers die within a week or two, but the rest recover without significant organ damage, according to WHO.

Pastor Jim and Lori Bakker welcome special guest Pastor Carl Gallups as they discuss the increase of knowledge in information, transportation, and communication technology in these last days.Continue reading →